Browse categories and answer follow-up questions to refine your symptom profile.
Immediate priorities
Stabilization priorities
Airway risk
Oropharyngeal edema
Stridor
Copious oral secretions
Inability to handle secretions
Breathing risk
Tachypnea
Hypoxemia
Suspected aspiration
Suspected pneumonia
Circulation risk
Hypotension
Lactic acidosis
Altered mental status
Oliguria
Immediate escalation triggers
If airway compromise suspected, early anesthesia and ICU
If shock physiology, resuscitation bay and sepsis pathway
Remove trigger and stop progression
Culprit exposure control
Immediate discontinuation of suspected causative medication
Highest suspicion for drugs started within prior 8 weeks
Avoid rechallenge with suspected agent
Medication reconciliation focus
Recent new prescriptions
Recent dose increases
Over the counter NSAIDs
Herbal supplements
Documentation essentials
Suspected drug listed as severe allergy with reaction SJS or TEN
Provide patient a written avoid list at discharge or transfer
Initial resuscitation and monitoring
Supportive care bundle
Large bore IV access
Two peripheral IVs
Consider central access if vasopressors anticipated
Temperature control
Warm environment
Active warming for hypothermia
Pain control
Early multimodal analgesia
Avoid NSAIDs if suspected trigger class
Fluids and perfusion targets
Balanced crystalloids preferred
Urine output target 0.5 mL/kg/hour adults
Urine output target 1 mL/kg/hour pediatrics
Hemodynamic monitoring
Continuous pulse oximetry
Cardiac monitoring
Frequent blood pressure cycling
Foley catheter for severe cases and strict I and O
Consults and destination planning
Early specialty activation
Dermatology
Diagnostic confirmation support
Biopsy coordination
Systemic therapy discussion
Ophthalmology within 24 hours
Baseline ocular exam
Prevention of ocular sequelae
Burn surgery or burn center transfer
Significant epidermal detachment
Rapid progression
High SCORTEN
ICU
Hemodynamic instability
Respiratory compromise
Multiorgan involvement
Gynecology or urology
Genital mucosal involvement
Urinary retention
Nutrition
Early enteral planning
High caloric needs
Key Concepts
Core concepts
SJS and TEN are a spectrum of epidermal necrolysis with mucosal involvement
SJS definition less than 10 percent body surface area detachment
SJS TEN overlap definition 10 to 29 percent body surface area detachment
TEN definition 30 percent or more body surface area detachment
Early culprit drug withdrawal improves outcomes
Strong association with recent medication exposure
Death mechanisms
Sepsis
Fluid and electrolyte derangements
Multiorgan failure
PITFALLS
Common failure modes
Mislabeling as simple drug rash or urticaria
Delayed trigger withdrawal
Mislabeling as erythema multiforme major without mucosal severity assessment
Under triage of critical illness
Routine prophylactic antibiotics without infection evidence
Resistance and fungal overgrowth risk
Aggressive debridement of detached epidermis
Additional tissue injury risk
Delayed ophthalmology evaluation
Increased risk of long term vision loss
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.